Healthcare Provider Details

I. General information

NPI: 1811902349
Provider Name (Legal Business Name): CALDWELL MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 HICKORY BLVD UPPER SUITE
GRANITE FALLS NC
28630-1992
US

IV. Provider business mailing address

322 MULBERRY ST SW MEDICAL STAFF SERVICES
LENOIR NC
28645-5702
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5060
  • Fax: 828-757-5064
Mailing address:
  • Phone: 828-757-5965
  • Fax: 828-757-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA T SMITH
Title or Position: VP/ COO/CNO
Credential:
Phone: 828-757-5100